It was determined the needing for the TRS implementation and the mechanisms to provide continuity. The registry becomes an information source for the investigation developing. It was identified the causes of consult, morbidity and death due to trauma that will allow a better planning of the emergency services and of the regional trauma system in order to optimize and reduce the attention costs. Based on optimal information system it will be able to present the necessary adjusts to redesign the Trauma and Emergencies Attention System in the Colombian South-West.

There is very little data on the value of specialized intensive care unit (ICU) care in the literature. To determine if specialize ICU care for the trauma patient improved outcomes in this patient population. Level I Trauma Center Compared outcomes of trauma patients treated in a surgical trauma ICU (STICU) to those treated in non- trauma ICUs (non-STICU). Retrospective review of trauma registry data. Statistical Analysis: Wilcoxon Rank Test, Fischer's Exact test, logistic regression. There were 1146 STICU patients compared to 1475 non-STICU. In all ISS groups there were more penetrating trauma patients in the STICU (32.54% STICU vs. 18.15% non-STICU, P<0.0001 (ISS< 15)), (21.03% STICU vs. 12.98% non-STICU, P=0.0074 (ISS between 15-25)), and (19.42% STICU vs. 11.35% non-STICU, P=0.0026 (ISS> 25)). All groups had similar lengths of stay. The blunt trauma patients were sicker in the STICU (20.8 ISS ± 12.2 STICU vs. 19.7 ISS ± 11.9 non-STICU, P=0.03) yet had similar outcomes to the non-STICU group. Logistic regression identified penetrating trauma and not ICU location as a predictor of mortality. Sicker STICU patients do as well as less injured non-STICU patients. Severely injured patients should be preferentially treated in a STICU where they are better equipped to care for the complex multi-trauma patient. All patients, regardless of location, do well when their management is guided by a surgical critical care team.

This study evaluated a program designed to test and enhance residents’ knowledge of geriatrics. A 2-year prospective interventional trial was conducted. Surgical residents underwent pretesting (pre) in three areas: polypharmacy, delirium, and end of life. They then received educational materials and completed a posttest within 1 month and a patient simulation examination graded by a physician observer and the patient on his or her satisfaction. Forty-nine residents (51% interns, 55% general surgery residents) participated. Seventy per cent had no prior geriatrics education. Test scores significantly improved from pretest to posttest (12.9 ± 3.1 vs 13.78 ± 3.12, P = 0.01). The scores were consistently better on poly topics and consistently worse on end-of-life topics: pretest per cent correct: polypharmacy 60, end of life 46, P = 0.007; posttest percent correct: polypharmacy 63, end of life 49, P = 0.0014. By Pearson correlation, the pretest and posttest scores did not correlate with either the observer ( R = -0.16, P = 0.27 pre, R = -0.08, P = 0.59 post) or subscores ( R = -0.27, P = 0.11 pre, R = -0.13, P = 0.45 post), although the observer and subscore correlated with each other ( R = 0.35, P = 0.036). Performance was poor and did not correlate with better patient care by simulation. Other options for geriatric education need to be considered and evaluated.

RESUMEN Introducción El trauma es un problema de salud pública a nivel mundial. En Colombia, el país más violento de América Latina, no hay sistemas de registro que permitan conocer las tendencias en la atención del trauma, desde el manejo prehospitalario hasta el estatus final. En Colombia, se tienen registros de mortalidad por entes estatales pero hay una deficiencia de sistemas de información que permita conocer la situación real de la atención del paciente con trauma. Objetivo Describir la epidemiología de la atención por trauma en los servicios de urgencias de dos hospitales de referencia en la ciudad de Cali. Metodología Entre 21 noviembre 2011 y 30 abril 2012 se implementó el piloto del Registro Internacional de Trauma de la Sociedad Panamericana de Trauma; la captura de la información se realiza en tiempo real. Incluye la información socio-demográfica, etiologia, severidad del trauma y estatus al egreso. Resultados Se registraron 5432 pacientes. El promedio de edad fue 30,2 (±20,3) años, el 67,5% fueron <35 años. Las principales causas de consulta fueron las caídas (38,1%), lesiones de tránsito (12,2%) y heridas por arma de fuego (8,5%). El 34,4% (n = 1,867) requirieron procedimientos quirúrgicos, se hospitalizaron 18,9% (n = 1,029). La mortalidad global fue del 2,6%, mayormente secundarias a heridas por arma de fuego 54,3% (76/140). La mortalidad según severidad para ISS<15 fue 0,3%(13/5183) y con ISS>15 fue 64,5% (89/138). Conclusiones La mayor causa de consulta fueron las caídas (38,1%), la mayor proporción de muertes fue secundaria a heridas por arma de fuego. La implementación de un registro de trauma permite conocer la realidad de la atención del trauma en los servicios de urgencias, logrando identificar debilidades en el sistema de trauma, permitiendo la generación de nuevas estrategias para mejorar la atención del trauma que se traduce en impactos en las políticas públicas y en la optimización de recursos al interior de los hospitales. Objetivo Describir la situación actual de las consultas por trauma a los servicios de urgencias de dos hospitales de referencia de la ciudad de Cali, que en los cuales se ha adelantado el programa piloto del registro de trauma de la sociedad Panamericana de trauma. Y mostrar que la mayor causa de consulta a los servicios de urgencias son las caídas en todas en todos los rangos de edad.

Objective: To send an American fellow surgeon to a Panamerican country and quantify operative skills acquisition. Materials and methods:A second year surgical critical care fellow from a Level One Urban Trauma Center was sent to Cali, Colombia from April 1 to 21, 2013. The operative experience was evaluated. Total cases, first time cases, and first time procedures, defined as technical portions within trauma cases, were recorded. Results:In 20 operative days, 172 total cases were performed in the following categories: burn 112, trauma 19, emergent general 16, elective general 14, plastics 8, and laparoscopic bariatric 3. First exposure operations included 46/112 burn cases, 8/8 trauma/burn reconstructive cases, 1/16 emergent general cases, 11/14 elective general cases, and 3/3 laparoscopic bariatric cases. Of the 19 total trauma operations (not including 2 amputations), 3 left anterolateral thoracotomies, 2 clamshell thoracotomies, 1 diagnostic laparoscopy, 1 open pericardial window, 10 exploratory laparotomies and 2 relaparotomies were performed. The 19 trauma operations consisted of 26 (not including the 2 amputations) procedures. Twenty-three percent were first time performed trauma procedures (6/26, not including amputations).Nearly 9 (8.6) operations were performed per day. In five 12-hour shifts of trauma call, 19 operations were performed within 60 hours. One trauma operative case was performed for every 3.15 hours worked. Conclusion:In the current era of American trauma training in which penetrating trauma and total number of operative cases is concentrated to specific centers in the United States, additional methods in education and experience should be sought for the American trauma fellow. This is the first reported international trauma fellow rotation in Cali, Colombia, with an operative experience very different than standard and current opportunities. Our experience serves as a potential template for future endeavors in surgical education. Conclusión: En la era actual de la formación trauma estadounidense en la que el trauma penetrante y el número total de casos quirúrgicos se concentra a centros específicos en los Estados Unidos, los métodos adicionales en la educación y la experiencia debe buscarse la American Trauma Fellow. Este es el primer informe de compañero de trauma rotación internacional en Cali Colombia, con una experiencia operativa muy diferente a la estándar y oportunidades actuales. Nuestra experiencia sirve como plantilla potencial para futuros esfuerzos en la educación quirúrgica.Palabras claves: Communion trauma panaerica, Communion operative internacional, Rotacion trauma.